ABSTRACT
Neurosyphilis can present with various clinical symptoms. We report a patient with multiple cranial neuropathy that, mimicked tuberculosis, but was finally diagnosed as neurosyphilis. A 38-year-old man was admitted due to subacutely progressive hearing loss. Brain MRI revealed multiple dural enhanced masses on contrast-enhanced T1 weighted images. Brain biopsy of the dural enhanced lesion revealed chronic granulomatous inflammation with coagulation necrosis, compatible with syphilitic gumma. Serum venereal disease research laboratory and fluorescent treponemal antibody absorption test results were positive. Treatment with penicillin resolved the patient's symptom.
Subject(s)
Adult , Humans , Biopsy , Brain , Cranial Nerve Diseases , Fluorescent Treponemal Antibody-Absorption Test , Hearing Loss , Inflammation , Magnetic Resonance Imaging , Necrosis , Neurosyphilis , Penicillins , Sexually Transmitted Diseases , TuberculosisABSTRACT
In most cases, skull base osteomyelitis arises from infections of external auditory canal, middle ear or paranasal sinuses. On the other hand, atypical or central skull base osteomyelitis has no evidence of external otitis or other infection sources. It is often found located on clivus and involves lower cranial nerves and brainstem through the foramina of skull base. The overall rate of mortality reaches 10% and long-term neurologic sequelae are seen in additional 31% of cases regardless of aggressive treatment. We recently encountered a 68-year-old man with right facial pain and generalized headache, and we achieved good outcome with the recovery of vocal cord palsy and disappearance of headache by surgical debridement and long-term antibiotics. We report it with a review of literature.
Subject(s)
Aged , Humans , Anti-Bacterial Agents , Brain Stem , Cranial Fossa, Posterior , Cranial Nerve Diseases , Cranial Nerves , Debridement , Ear Canal , Ear, Middle , Facial Pain , Hand , Headache , Mortality , Osteomyelitis , Otitis Externa , Paranasal Sinuses , Skull Base , Vocal Cord ParalysisABSTRACT
Multiple cranial and peripheral neuropathies as a delayed sequellae of ethylene glycol poisoning is a less well known clinical entity and its information about long-term electrophysiological and clinical outcomes is limited. We report a 45-year-old male who presented with acute renal failure and subsequently developed multiple cranial neuropathy, respiratory failure, and flaccid tetraparesis. Through sequential electrophysiological studies, we would like suggest that the main pathophysiology of ethylene glycol-related neuropathy is a demyelinating polyradiculoneuropathy with secondary axonal degeneration.